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Two long-axis dimensions of hippocampal-cortical integration support memory function across the adult lifespan.
No full textThe hippocampus is a complex structure critically involved in numerous behavior-regulating systems. In young adults, multiple overlapping spatial modes along its longitudinal and transverse axes describe the organization of its functional integration with neocortex, extending the traditional framework emphasizing functional differences between sharply segregated hippocampal subregions. Yet, it remains unknown whether these modes (i.e. gradients) persist across the adult human lifespan, and relate to memory and molecular markers associated with brain function and cognition. In two independent samples, we demonstrate that the principal anteroposterior and second-order, mid-to-anterior/posterior hippocampal modes of neocortical functional connectivity, representing distinct dimensions of macroscale cortical organization, manifest across the adult lifespan. Specifically, individual differences in topography of the second-order gradient predicted episodic memory and mirrored dopamine D1 receptor distribution, capturing shared functional and molecular organization. Older age was associated with less distinct transitions along gradients (i.e. increased functional homogeneity). Importantly, a youth-like gradient profile predicted preserved episodic memory - emphasizing age-related gradient dedifferentiation as a marker of cognitive decline. Our results underscore a critical role of mapping multidimensional hippocampal organization in understanding the neural circuits that support memory across the adult lifespan
Advancements in Medicinal Plant Identification Using Deep Learning Techniques: A Comprehensive Review
No full textDeep learning has emerged as a transformative approach in medicinal plant identification, addressing the critical need for accurate and scalable solutions to support biodiversity conservation, traditional medicine, and sustainable healthcare practices. This systematic literature review examines 30 papers on deep learning for medicinal plant identification, revealing diverse approaches across global contexts. Convolutional neural networks emerge as the primary technique, achieving high accuracy, particularly with leaf-based identification. Data collection methods vary, with manual fieldwork predominating. The review highlights challenges in scaling to larger species sets and using crowdsourced data, though strategies like data augmentation show promise. Plant state and maturity impact model performance, warranting further investigation. The geographical distribution of studies emphasizes the global relevance of this research, with India and China contributing the most. Mobile applications offer potential for deployment and data collection but lack robust user feedback mechanisms for model refinement. The review identifies gaps in continuous model updating and suggests exploring incremental and zero-shot learning. Overall, the field shows promise but requires more balanced datasets and context-aware approaches to maximize real-world impact in medicinal plant identification
Thoracic Cancer Exercise Services in Australia: A Point-Prevalence Survey
No full textBACKGROUND: Cancer guidelines recommend pre- and rehabilitation; however, current research shows these services are not well integrated into clinical practice. To date, there has been no prospective audit of Australian lung cancer exercise services or the people accessing these services. The aim of this study was to describe the exercise pre- and rehabilitation services available to people with thoracic cancer and the characteristics of people with thoracic cancer attending these services in Australia. METHODS: Prospective, observational, multicenter, 5-day, point-prevalence study. Australian healthcare services likely to provide exercise services to people with thoracic cancer were contacted to participate. Conduct and reporting followed the CROSS guidelines. RESULTS: A total of 397 services were contacted, and 203 responded (51%). Overall, 67% (n = 137) accepted thoracic cancer referrals, and 107 (78%) completed the survey. Most exercise services were targeted at respiratory disease (58%, n = 60) compared with 31% cancer-specific (n = 33) and 5% lung cancer-specific (n = 5). A total of 73 patients with thoracic cancer attended programs across 41 sites (38%). Mean (SD) age was 68.5 (9.7) years. Overall, 4% of patients (n = 3) were culturally and linguistically diverse, and none identified as Aboriginal or Torres Strait Islander. A total of 19 outcomes were used in 51 combinations to assess participants (n = 70), and 12 exercise interventions were delivered in 45 combinations (n = 67). CONCLUSIONS: One-third of responding exercise programs did not offer exercise services to people with thoracic cancer. Almost two-thirds of services that accept referrals did not have a thoracic cancer patient attend their service. High heterogeneity in outcome measures and exercise interventions was observed
Broken by and breaking of: Interrogating the ableist norms around impaired speech
No full text© 2025 Lesley Ellen ChampionThis thesis explores how impaired speech is broken by the ableist norms of compulsory fluency that demand sovereign and masterful speech. It examines how impaired speakers engage with these norms, sometimes drawing on them but often resisting them in asserting their competence as speakers. This thesis challenges dominant ableist norms by attending to how speakers navigate and renegotiate these norms to turn towards a more relational understanding of speech.
Expectations of sovereign and masterful speakers contribute to the stigma that devalues the existence and contribution of impaired speech (Beasley, 2021; Inahara, 2013), and impaired speakers, those who speak in ways that diverge from cultural norms, often experience negative outcomes. Impaired speech has been linked to difficulty entering into social interaction, social withdrawal and isolation (C. Butler, 2013; Dickson et al., 2008; Miller et al., 2006), experiences that limit how impaired speakers can participate in and contribute to our society.
Historically dominant views of speech, such as those represented within the field of speech pathology, are built upon ideals of the masterful and independent transfer of information from one individual to another (S. Barnes & Bloch, 2019; Beukelman et al., 2013; A. Duffy, 2018). These ideals are damaging for impaired speech and often serve to render broken speech that fails to conform to expectations of able-bodiedness. There is a paucity of research exploring the day-to-day experiences and social landscapes of impaired speakers (Dickson et al., 2008; Miller et al., 2006), and an even greater absence of work applying a critical lens to impaired speech to investigate impaired speech as being shaped through networks of ableist norms.
This thesis instead employs the framework of ableism (Campbell, 2009) to interrogate these breaks, exploring how impaired speakers interact with them and articulate alternatives. The research was conducted in three stages: a systematic review of a body of literature around ‘broken narratives’; an online survey with seven impaired speakers; and online interviews with five impaired speakers. Through these studies, I draw heavily on the work of Campbell (2009) and Moser (2005), to not only trace the through-lines of ableist norms within participants' narratives, but also to place the emphasis back on how impaired speakers work with these discourses, either assimilating and adapting them into their own understandings of themselves or going their own way and finding new ways of being.
I argue that impaired speech is broken primarily not by its physical or acoustic properties, but by cultural expectations of what a good speaker must be. I also contend that the narratives of impaired speakers offer us tools for thinking about impaired speech in new and productive ways, displacing the ideal of the sovereign and masterful speaker in favour of an understanding of speech as a relational and interdependent achievement. Norms of mastery, autonomy and boundedness emerged as sites of tension within their narratives. However, in the process of navigating these norms, I argue that impaired speakers break away from them, gesturing towards subversive understandings of speech where speech emerges in the relationships between speakers, objects and listeners.
Ultimately, this thesis contributes to an under-researched area of disability, and facet of ableism, by challenging ableist norms around speech and working to expand the possibilities for talking about impaired speech. By recognising the relational and interdependent nature of speech, we can find ways of breaking through ableist norms to understand impaired speech, and those who speak in ways that challenge ableist norms, in new, respectful, inclusive, and productive ways
Expert consensus on the optimal management of BRAFV600E-mutant metastatic colorectal cancer in the Asia-Pacific region
No full textThe burden of colorectal cancer (CRC) is high in the Asia-Pacific region, and several countries in this region have among the highest and/or fastest growing rates of CRC in the world. A significant proportion of patients will present with or develop metastatic CRC (mCRC), and BRAFV600E-mutant mCRC represents a particularly aggressive phenotype that is less responsive to standard chemotherapies. In light of recent therapeutic advances, an Asia-Pacific expert consensus panel was convened to develop evidence-based recommendations for the diagnosis, treatment, and management of patients with BRAFV600E-mutant mCRC. The expert panel comprised nine medical oncologists from Australia, Hong Kong, Singapore, and Taiwan (the authors), who met to review current literature and develop eight consensus statements that describe the optimal management of BRAFV600E-mutant mCRC in the Asia-Pacific region. As agreed by the expert panel, the consensus statements recommend molecular testing at diagnosis to guide individualized treatment decisions, propose optimal treatment pathways according to microsatellite stability status, advocate for more frequent monitoring of BRAFV600E-mutant mCRC, and discuss local treatment strategies for oligometastatic disease. Together, these expert consensus statements are intended to optimize treatment and improve outcomes for patients with BRAFV600E-mutant mCRC in the Asia-Pacific region
Effects of maternal healthcare service utilization on modern postpartum family planning access in Bangladesh: insights from a National representative survey
No full textBACKGROUND: Access to modern family planning is critical for improving maternal and child health outcomes, yet it remains severely lacking in low- and middle-income countries, including Bangladesh. Maternal healthcare utilization during and after pregnancy is vital for promoting postpartum family planning. This study examined the effects of maternal healthcare service utilization on postpartum family planning uptake in Bangladesh. METHODS: Reproductive calendar data from 4,081 women with recent live births were extracted from the cross-sectional 2017/18 Bangladesh Demographic and Health Survey and analyzed. The outcome variable was uptake of modern postpartum family planning methods and the exposure variables were different types of maternal healthcare services. Kaplan-Meier methods were used to calculate cumulative probabilities of modern postpartum family planning method uptake within 12 months post-delivery, and modified Poisson regression models were used to estimate the effects of utilizing maternal healthcare services on modern postpartum family planning method uptake. RESULTS: Modern family planning methods in the 12 month postpartum period were used by 72% of women, with over 60% starting after day 40. Less than 4% used long-acting family planning methods, while almost 40% relied on the oral contraceptive pill. Utilizing maternal healthcare services was associated with up to a 7% higher uptake of modern postpartum family planning methods compared to non-users. CONCLUSION: Three-quarters of Bangladeshi women use modern family planning within the 12 months postpartum, but often rely on less effective methods. Additionally, 25% of these women resort to traditional or no use of contraceptive methods, increasing the risks of unintended pregnancy, short birth intervals, and adverse maternal and infant health outcomes. Maternal healthcare services, including private facilities, should prioritize modern postpartum family planning provision, along with education and counseling on the benefits of long-acting contraception
Observational Diagnostics: The Building Block of AI-Powered Visual Aid for Dental Practitioners
No full textArtificial intelligence (AI) has gained significant traction in medical image analysis, including dentistry, aiding clinicians in making timely and accurate diagnoses. Radiographs, such as orthopantomograms (OPGs) and intraoral radiographs, along with clinical photographs, are the primary imaging modalities employed for AI-powered analysis in the dental field. In this review, we discuss the most recent research and product developments concerning the clinical application of AI as a visual aid in dentistry and introduce the concept of Observational Diagnostics (ODs) as a structured method to standardise image analysis. ODs serve as foundational elements for AI-driven diagnostic aids and have the potential to improve the consistency and reliability of diagnostic data used in treatment planning. We provide illustrative examples to demonstrate how ODs not only represent a significant advancement towards more precise diagnostic aids but also provide the basis for the generation of evidence-based treatment recommendations. These OD-based algorithms have been integrated into chairside AI applications to streamline clinical workflows to improve consistency, accuracy, and efficiency
Pharmacotherapy in Comorbid Bipolar Disorder and Post-Traumatic Stress Disorder From the STEP-BD Cohort
No full textINTRODUCTION: Post-traumatic stress disorder (PTSD) is more prevalent in those with bipolar disorder (BD) than in the general population, with rates of PTSD as high as 55% in some BD cohorts. Despite this, little research explores the effects of pharmacotherapy treatments in those with comorbid BD and PTSD. This study aims to explore patterns of pharmacotherapy use at baseline and their impact on symptoms in individuals with BD alone and comorbid BD and PTSD. METHODS: The Systematic Treatment Enhancement Program for BD (STEP-BD) cohort was utilised to examine and compare BD symptoms and pharmacotherapy treatments between those with BD alone (n = 3393) and those with comorbid BD and PTSD (n = 304). We conducted regression models to compare those with and without comorbid PTSD. Models included measures of depression, mania, functioning and quality of life over 24 months of the STEP-BD study. We included baseline pharmacotherapies (lithium, valproate, antidepressants, antipsychotics and benzodiazepines) as predictor outcome variables in all models. RESULTS: At baseline, reported use of lithium was lower in the comorbid BD and PTSD group, while the use of antidepressants, antipsychotics and benzodiazepines was significantly higher in the comorbid BD and PTSD than in the BD alone group. Benzodiazepine use was associated with a small improvement in depression symptom scores and poorer quality of life in those with comorbid BD and PTSD. Lastly, those with comorbid PTSD experienced higher levels of mania and depression symptoms and lower functioning and quality of life compared to BD alone, irrespective of pharmacotherapy treatment. CONCLUSION: Clinical trial participants with BD and PTSD reported worse symptoms and outcomes across 24 months of the STEP-BD study compared to those without comorbid PTSD, regardless of baseline medication use. These results highlight the importance of considering comorbidity in the treatment of mental health conditions, specifically BD, and the need for further exploration of effective treatment options
Rethinking the residual approach: leveraging statistical learning to operationalize cognitive resilience in Alzheimer’s disease
No full textCognitive resilience (CR) describes the phenomenon of individuals evading cognitive decline despite prominent Alzheimer’s disease neuropathology. Operationalization and measurement of this latent construct is non-trivial as it cannot be directly observed. The residual approach has been widely applied to estimate CR, where the degree of resilience is estimated through a linear model’s residuals. We demonstrate that this approach makes specific, uncontrollable assumptions and likely leads to biased and erroneous resilience estimates. This is especially true when information about CR is contained in the data the linear model was fitted to, either through inclusion of CR-associated variables or due to correlation. We propose an alternative strategy which overcomes the standard approach’s limitations using machine learning principles. Our proposed approach makes fewer assumptions about the data and CR and achieves better estimation accuracy on simulated ground-truth data
Fluid responsiveness and hypotension in patients undergoing propofol-based sedation for colonoscopy following bowel preparation: a prospective cohort study
No full textPURPOSE: Fasting and bowel preparation may deplete intravascular volume in patients undergoing colonoscopy. Nevertheless, rigorous demonstration of volume depletion and assessment of clinical consequences is lacking. We designed this study to explore the relationship between intravascular volume status and intraprocedural hypotension and to compare transthoracic echocardiography (TTE) and the ClearSight™ (Edwards Lifesciences, Irvine, CA, USA) noninvasive cardiac output monitor to measure intravascular volume status. METHODS: We recruited adult patients undergoing elective colonoscopy following bowel preparation at the Royal Melbourne Hospital. We assessed the volume status preprocedure by taking TTE and ClearSight measurements in patients in the semirecumbent position and following passive leg raising. Patients received propofol-based sedation, and significant intraprocedural hypotension was defined as a mean arterial pressure (MAP) < 60 mm Hg. The primary outcome was the occurrence of intravascular volume depletion as assessed by a positive result in a passive leg raise test on TTE (a 15% increase in the subaortic velocity time integral). RESULTS: Ninety-nine patients completed the study. The primary outcome was recorded in 29 of the 90 patients with adequate TTE images (32%; 95% confidence interval, 23 to 43). There was inadequate agreement between average TTE and ClearSight measurements of stroke volume at baseline or after passive leg raising. More patients experienced significant intraprocedural hypotension in the fluid-responsive group (48%) than in the normovolemic group (21%). CONCLUSION: Patients undergoing elective colonoscopy after bowel preparation were often fluid responsive. These patients were more likely to have significant intraprocedural hypotension than patients who were volume replete. Transthoracic echocardiography assessment of volume status cannot be readily replaced by ClearSight monitoring. STUDY REGISTRATION: ANZCTR.org.au ( ACTRN12616000614493 ); first registered 11 May 2016